Trans-anal protrusion of intussusception (TAPI) revisited: managed successfully in a resource limited hospital setting

Intussusception is the most common cause of Acute bowel obstruction in infants and toddlers. However, a Trans-anal protrusion of an intussusception (TAPI) is relatively rare and is not well reported in literature. A high index of suspicion is essential as the diagnosis is purely clinical, and often confused with rectal prolapse. Most patients present late due to neglect on the part of the parents or the primary treating physician. A late presentation usually results in a poor outcome and increased morbidity and mortality. Uncommonly these children may present early, where a prompt surgical management is desirable. The author reports a single case of a Trans anal protrusion of intussusception (TAPI) in a 1-½ -year old female child who was successfully managed in the author's resource-limited teaching institution without a dedicated pediatric surgery unit.

Peritoneal Dialysis Catheter Removal Post-Transplant — A Rare Case of Delayed Bowel Perforation

Peritoneal dialysis (PD) is a well-established form of renal replacement therapy and the practice of leaving catheters in situ post-transplantation widely accepted. We present a rare complication: a child presenting with anal protrusion of the PD catheter.The patient is an 11-year-old boy with a background of renal dysplasia and congenital cutis laxa. Twenty-three weeks after dialysis was commenced, the patient underwent a renal transplant. Thirteen weeks post-transplant, the patient felt an unusual sensation after defecation. The curled end of the catheter was seen protruding from the anus. He was admitted, and investigations showed stable graft function, with abdominal X ray showing no free air.Intraoperative findings showed a small perforation of the sigmoid colon sealed off by adherence of several small intestinal loops. This was repaired laparoscopically after removal of the distal part of the catheter per rectum. No peritoneal contamination was seen. He was treated with 5 days of intravenous antibiotics and gradual introduction of enteral feeds. His graft function remained stable throughout.Timing of catheter removal varies, from the time of transplantation to over 3 months post-transplantation. Bowel perforation due to PD catheter insertion is rare and tends to occur at the time of insertion. Anal protrusion of a PD catheter in childhood is extremely rare and unrecorded in a pediatric patient with a connective tissue disorder. Our case highlights that serious complications can occur in the period between transplantation and elective PD catheter removal and that, in the immunocompromised patient, signs can be subtle.